How much does Medicare pay for CPT 96904?

Medicare allowed an average of $71.03 per service and paid $52.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $147.07, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96904?

Photograph of entire body. It was billed 1,406 times to 1,285 Medicare beneficiaries by 15 providers in 2024.

Which specialty bills 96904 most?

Dermatology, with 1,003 services from 8 clinicians. Next are Pathology, Internal Medicine, Nurse Practitioner.

CPT 96904

Photograph of entire body

$71.03Medicare-allowed amount per service, averaged across 1,406 services

Providers submitted

$147.07

Asking price, not received

Medicare allowed

$71.03

The fee schedule figure

Medicare paid

$52.93

Balance is patient coinsurance

Providers submitted an average of $147.07 for this code and Medicare allowed $71.03 — 2.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $52.93 (75%); the rest is the patient’s coinsurance and deductible.

Services: 1,406
Beneficiaries: 1,285
Providers billing it: 15
Total allowed: $99,868

What Medicare pays for CPT 96904

Across 1,406 services billed by 15 providers to 1,285 beneficiaries, Medicare allowed an average of $71.03 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 96904

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	1,003	946	$73.15	8
Pathology	131	111	$60.95	1
Internal Medicine	108	106	$80.22	1
Nurse Practitioner	75	49	$54.38	1
Physician Assistant	39	37	$59.54	2
Plastic and Reconstructive Surgery	39	25	$70.62	1
Radiation Oncology	11	11	$63.72	1

96904 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Connecticut	614	$73.56	$49.45	1
New York	221	$71.32	$48.08	3
California	200	$78.22	$49.91	3
Michigan	131	$60.95	$53.74	1
Texas	114	$63.79	$42.82	2
Florida	62	$63.49	$50.81	3
Ohio	46	$61.51	$53.77	1
Pennsylvania	18	$71.03	$53.72	1

Related codes

96910Therapy procedure$122.72
96900Application of ultraviolet light to skin$24.96
96920Treatment of inflammatory skin disease$159.83
96921Treatment of inflammatory skin disease$181.15
96922Treatment of inflammatory skin disease$249.51

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.